Healthcare Provider Details

I. General information

NPI: 1366856536
Provider Name (Legal Business Name): STACY MARIE GUTIERREZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 FANNIN ST
HOUSTON TX
77030-2703
US

IV. Provider business mailing address

20003 MAHOGANY RIDGE DR
MAGNOLIA TX
77355-4996
US

V. Phone/Fax

Practice location:
  • Phone: 713-790-3311
  • Fax:
Mailing address:
  • Phone: 443-955-9836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP142069
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number898509
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number754202
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number202997
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: